Proximal Tibial Reconstruction After Tumor Resection

Abstract

Background: The proximal part of the tibia is a common location for primary bone tumors, and many options for reconstruction exist following resection. This anatomic location has a notoriously high complication rate, and each available reconstruction method is associated with unique risks and benefits. The most commonly utilized implants are metallic endoprostheses, osteoarticular allografts, and allograft-prosthesis composites. There is a current lack of data comparing the outcomes of these reconstructive techniques in the literature.Methods: A systematic review of peer-reviewed observational studies evaluating outcomes after proximal tibial reconstruction was conducted, including both aggregate and pooled data sets and utilizing a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) review for quality assessment. Henderson complications, amputation rates, implant survival, and functional outcomes were evaluated.Results: A total of 1,643 patients were identified from 29 studies, including 1,402 patients who underwent reconstruction with metallic endoprostheses, 183 patients who underwent reconstruction with osteoarticular allografts, and 58 patients who underwent with reconstruction with allograft-prosthesis composites. The mean follow-up times were 83.5 months (range, 37.3 to 176 months) for the metallic endoprosthesis group, 109.4 months (range, 49 to 234 months) for the osteoarticular allograft group, and 88.8 months (range, 49 to 128 months) for the allograftprosthesis composite reconstruction group. The mean patient age per study ranged from 13.5 to 50 years. Patients with metallic endoprostheses had the lowest rates of Henderson Type-1 complications (5.1%; p , 0.001), Type-3 complications (10.3%; p , 0.001), and Type-5 complications (5.8%; p , 0.001), whereas, on aggregate data analysis, patients with an osteoarticular allograft had the lowest rates of Type-2 complications (2.1%; p , 0.001) and patients with an allograft-prosthesis composite had the lowest rates of Type-4 complications (10.2%; p , 0.001). The Musculoskeletal Tumor Society (MSTS) scores were highest in patients with an osteoarticular allograft (26.8 points; p , 0.001). Pooled data analysis showed that patients with a metallic endoprosthesis had the lowest rates of sustaining any Henderson complication (23.1%; p 5 0.009) and the highest implant survival rates (92.3%), and patients with an osteoarticular allograft had the lowest implant survival rates at 10 years (60.5%; p 5 0.014).Conclusions: Osteoarticular allograft appears to lead to higher rates of Henderson complications and amputation rates when compared with metallic endoprostheses. However, functional outcomes may be higher in Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/ JBJSREV/A470).

<p>Intercalary Reconstruction of the “Ultra-Critical Sized Bone Defect” by 3D-Printed Porous Prosthesis After Resection of Tibial Malignant Tumor</p>

“…Osteoarticular allograft has better post-operative limb function when compared with metallic prosthesis reconstruction. 32 This indicates the benefits of biological reconstruction for function restore, and the importance of adjacent residual bone preservation. We preserved the distal tibiofibular syndesmosis in case 3 with 0.6 cm distal tibia left after segmental resection.…”

Modular prosthetic reconstruction for primary bone tumours of the distal tibia in ten patients

“…For comparison, the final amputation rate after limb-sparing surgery for tumours of the proximal tibia is around 10%. 12 In the proximal tibia, there are similar problems to the distal tibia of soft tissue coverage and restoring active joint function. The reason why amputation is seldom the procedure of choice for the proximal tibia is probably that a knee disarticulation or through-thigh amputation is considered more debilitating than a below-knee amputation.…”

Squamous Cell Carcinoma Arising from Chronic Osteomyelitis in the Extremities: Treatment Approach and Oncological Outcomes—A Systematic Review of the Literature

“…Articles with >11 points were included. STROBE assessment followed the strategy described by Summers SH et al (Supplementary material 2 ) [ 43 ]. For this checklist, 10 of the available 22 items were utilized.…”